Title: An Exploration of Racial Differences in End-of-Life Care Preferences Among Cancer and CHF Patients in South Carolina Abstract: We need to better understand the reasons behind the apparent racial disparities in the use of end-of-life or palliative care options. The most important overall goal of this proposed study is to better understand racial differences in preferences for end of life care in South Carolina, particularly with respect to African Americans, and to then make this information available to those who will eventually develop strategies to appropriately address these differences. We will use face-to-face surveys of both physicians and their patients (with end-stage cancers and terminal congestive heart failure, as defined using standard guidelines) to gain a better understanding of communication issues related to end of life decision making. The proposed study would attempt to anser three major questions, focusing on end of life care preferences held by cancer and Congestive Heart Failure (CHF). The proposed study would attempt to answer three major research questions, focusing on end of life care preferences held by cancer and Congestive Heart Failure (CHF) patients in a South Carolina population with significant numbers of African Americans and medically underserved individuals. 1. Is there better agreement between physicians and Caucasian patients than physicians and African American patients regarding whether end of life options were discussed? 2. To what extent are there racial differences in end of life care utilization preferences between African American and Caucasian cancer and CHF patients, after controlling for the patients' clinical condition, income, age, gender, education, family structure, residence (urban or rural) and insurance states (private, public or uninsured)? 3. If significant racial differences in preferences are found to exist after controlling for the patients conditions (as set forth in question 1), are the differences significantly related to different patient-provider communication patterns by race, after also controlling for provider variables, such as professional specialization, years in practice, race, age, gender, institutional affiliation (community hospital or specialized center) and practice setting (solo or group practice)? 4. Do providers believe that their African American patients have different beliefs and preferences about end of life are than their Caucasian patients, and do these provider beliefs affect their communication patients?